Your first outbreak, and what to expect

If you have just been diagnosed and what you actually need is the steadier, less clinical version of this, start with just diagnosed instead. This page is the practical one.

What usually happens

The NHS describes the symptoms of genital herpes as small blisters that burst to leave red, open sores around the genitals, anus, thighs or bottom, along with tingling, burning or itching, pain when passing urine, and unusual discharge.

With a first episode, many people also feel unwell more generally for a few days — achy, feverish, run down, rather like fighting off flu. That combination can be alarming if nobody has told you to expect it.

It is worth saying clearly: a first episode is typically the most severe one a person has. It is not a preview of what every recurrence will be like. Later ones are usually shorter and milder, and for most people become less frequent over time.

The five-day window

This is the single most useful thing to know, because it is time-limited and most people do not know it.

The NHS says antiviral medicine is prescribed for a first infection to stop the symptoms getting worse, and that it needs to be started within five days of the symptoms appearing. BASHH frames the same window as within five days of the start of the episode, while new lesions are still forming, with review at day five and treatment continued to seven to ten days if new lesions are still appearing.

How it is diagnosed

Diagnosis is done from the sore itself. The NHS describes a clinician using a small cotton bud (swab) to take some fluid from one of your blisters for testing.

Two consequences follow, and both catch people out. Testing generally cannot be done without visible sores — which is the other reason not to wait for it to heal. And the test cannot tell you how long you have had the virus or who you acquired it from. Anyone drawing conclusions about timing or fidelity from a positive swab is over-reading it. More in herpes testing.

Where to go

A sexual health clinic is the right place, not because a GP cannot help, but because clinics are set up for exactly this. The NHS notes that many offer a walk-in service and often get results back faster than GP practices. You do not need a referral, and it is free.

If you are weighing that against a private route, we set out the comparison honestly — including where the NHS is simply the better option — in NHS or Interval.

When it is urgent

Seek help urgently, rather than waiting for an appointment, if:

• you cannot pass urine, or it is becoming very difficult
• the pain is severe and not manageable
• you feel seriously unwell
• you are pregnant and think you may be having a first episode — see herpes and pregnancy
• you have a weakened immune system

If you are unsure and cannot get seen, NHS 111 is the right call.

What comes after

Once the first episode settles, the picture usually changes considerably. Recurrences are shorter and milder, they tend to become less frequent over the years, and many people find the practical side of it fades quickly into the background.

The part that often takes longer is not physical. If the thing weighing on you is telling someone, that has its own page: telling a partner.